Usefulness of Dermoscopy in Localized Scleroderma (LoS, Morphea) Diagnosis and Assessment-Monocentric Cross-Sectional Study

Abstract

Morphea, also known as localized scleroderma (LoS), is a chronic autoimmune disease of the connective tissue. The clinical picture of LoS distinguishes between active and inactive lesions. Sometimes the clinical findings are challenging to identify, and therefore, the need for additional methods is emphasized. Our study aimed to demonstrate the characteristic dermoscopic features in morphea skin lesions, focusing on demonstrating features in active and inactive lesions. In our patients (n = 31) with histopathologically proven LoS, we performed clinical evaluation of lesions (n = 162): active/inactive and according to both disease activity (modified localized scleroderma severity index, mLoSSI) and damage (localized scleroderma skin damage index, LoSDI) parameters. In addition, we took into account compression locations to determine whether skin trauma, a known etiopathogenetic factor in LoS, affects the dermoscopic pattern of the lesions. We performed a dermoscopy of the lesions, categorizing the images according to the severity within the observed field. We showed that within the active lesions (clinically and with high mLoSSI), white clouds and linear branching vessels had the highest severity. These features decreased within the observed field in inactive lesions and with high LoSDI. Brownish structureless areas were most intense in inactive lesions with high LoSDI. Erythematous areas, linear branching vessels, dotted vessels, and crystalline structures were statistically significant for pressure locations. We have shown dermoscopy is a valuable tool to assess the activity or inactivity of lesions, which translates into appropriate therapeutic decisions and the possibility of monitoring the patient during and after therapy for possible relapse.

Keywords: dermoscopy; localized scleroderma; morphea.

Figure 1

Compression locations considered.

Figure 2

The orange box shows 4 dermoscopic images of active LoS lesions. The red asterisks mark the white clouds. Linear branching vessels are also seen scattered throughout the field. The blue box shows two dermoscopic images of active LoS lesions. Dotted vessels are visible, as well as widely scattered fine white clouds. The green frame shows a dermoscopic image of inactive lesions. The presence of reticulated brown areas is notable.